Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage
Background As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Kerman University of Medical Sciences
2018-08-01
|
| Series: | International Journal of Health Policy and Management |
| Subjects: | |
| Online Access: | http://www.ijhpm.com/article_3472_3b525fb580779b86a9363bc2fe658bbe.pdf |
| _version_ | 1819148336551165952 |
|---|---|
| author | Samia A. Hurst Mélinée Schindler Susan D. Goold Marion Danis |
| author_facet | Samia A. Hurst Mélinée Schindler Susan D. Goold Marion Danis |
| author_sort | Samia A. Hurst |
| collection | DOAJ |
| description | Background
As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy.
Methods
We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture.
Results
Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing.
Conclusion
Swiss participants who have engaged in a priority setting exercise accept complex resource allocation tradeoffs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved. |
| first_indexed | 2024-12-22T13:44:06Z |
| format | Article |
| id | doaj.art-a7f702c2c78f4797b7edeb61011042d8 |
| institution | Directory Open Access Journal |
| issn | 2322-5939 2322-5939 |
| language | English |
| last_indexed | 2024-12-22T13:44:06Z |
| publishDate | 2018-08-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-a7f702c2c78f4797b7edeb61011042d82022-12-21T18:23:51ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392322-59392018-08-017874675410.15171/IJHPM.2018.15Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance CoverageSamia A. Hurst0Mélinée Schindler1Susan D. Goold2Marion Danis3Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, SwitzerlandInstitute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, SwitzerlandDepartment of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USADepartment of Bioethics, National Institutes of Health, Bethesda, MD, USABackground As universal health coverage becomes the norm in many countries, it is important to determine public priorities regarding benefits to include in health insurance coverage. We report results of participation in a decision exercise among residents of Switzerland, a high-income country with a long history of universal health insurance and deliberative democracy. Methods We adapted the Choosing Healthplans All Together (CHAT) tool, an exercise developed to transform complex healthcare allocation decisions into easily understandable choices, for use in Switzerland. We conducted CHAT exercises in twelve Swiss cities with recruitment from a range of socio-economic backgrounds, taking into account differences in language and culture. Results Compared to existing coverage, a majority of 175 participants accepted greater general practice gatekeeping (94%), exclusion of invasive life-sustaining measures in dying patients (80%), longer waiting times for non-urgent episodic care (78%), greater adherence to cost-effectiveness guidelines in chronic care (66%), and lower premium subsidies (51%). Most initially chose greater coverage for dental care (59%), quality of life (57%), and long-term care (90%). During group deliberations, participants increased coverage for out-of-pocket costs (58%) and mental health to current levels (41%) and beyond current levels for rehabilitation (50%), and decreased coverage for quality of life to current levels (74%). Following group deliberation, they tended to change their views back to below current coverage for help with out-of-pocket costs, and back to current levels for rehabilitation. Most participants accepted the plan as appropriate and fair. A significant number would have added nothing. Conclusion Swiss participants who have engaged in a priority setting exercise accept complex resource allocation tradeoffs in healthcare coverage. Moreover, in the context of a well-funded healthcare system with universal coverage centered on individual choice, at least some of our participants believed a fully sufficient threshold of health insurance coverage was achieved.http://www.ijhpm.com/article_3472_3b525fb580779b86a9363bc2fe658bbe.pdfResource AllocationPriority SettingPublic ParticipationUniversal Insurance System |
| spellingShingle | Samia A. Hurst Mélinée Schindler Susan D. Goold Marion Danis Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage International Journal of Health Policy and Management Resource Allocation Priority Setting Public Participation Universal Insurance System |
| title | Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage |
| title_full | Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage |
| title_fullStr | Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage |
| title_full_unstemmed | Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage |
| title_short | Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage |
| title_sort | swiss chat citizens discuss priorities for swiss health insurance coverage |
| topic | Resource Allocation Priority Setting Public Participation Universal Insurance System |
| url | http://www.ijhpm.com/article_3472_3b525fb580779b86a9363bc2fe658bbe.pdf |
| work_keys_str_mv | AT samiaahurst swisschatcitizensdiscussprioritiesforswisshealthinsurancecoverage AT melineeschindler swisschatcitizensdiscussprioritiesforswisshealthinsurancecoverage AT susandgoold swisschatcitizensdiscussprioritiesforswisshealthinsurancecoverage AT mariondanis swisschatcitizensdiscussprioritiesforswisshealthinsurancecoverage |